APPLICATION FOR OCCUPANCY RETAIL SPACE

BUSINESS INFORMATION

Legal Name of Business:_____________________________________________________________________________

D/B/A: (if different from Legal Name) ___________________________________________________________________

Type of Organization: □Proprietorship □C-Corp. □S-Corp. □General Partnership □Limited Partnership □Non-Profit

□L.L.C. □L.L.P.

Address (Main Office): ______________________________________________________________________________ Number Street City State Zip

Federal Tax ID#/Employer ID #: _____________________ Number of Employees: _________ Yrs in Business: _______

Description of Business: _____________________________________________________________________________ Briefly describe the product sold or service rendered by your business (e.g. restaurant, flower shop, etc)

Gross Annual Revenue: _____________________________________________________________________________

Contact Person: _________________________________________________ Title: ___________________________

Emergency Contact Person: ________________________________________ Phone # (______)_________________

Business Phone # (______)_____________________________ Business Fax # (______)_________________________

Email: ______________________________________________ Website: _____________________________________

COMMERCIAL RENTAL HISTORY

Present Address: __________________________________________________________________________________ Number Street City State Zip

□Rent □Own Rental/Mortgage Amount Paid Monthly $_____________ From/To:_________________________

Reason for leaving: _________________________________________________________________________________

Landlord Name/Mortgage Co. _____________________________________ Phone # (______)_________________

Previous Address: _________________________________________________________________________________ Number Street City State Zip

□Rent □Own Rental/Mortgage Amount Paid Monthly $_____________ From/To _________________________

Reason for leaving: _________________________________________________________________________________

Landlord Name/Mortgage Co. _____________________________________ Phone # (______)_________________

BUSINESS FINANCIAL INFORMATION

Primary Bank: ___________________________________________________________________________

Contact Person: _________________________________________________ Title: ___________________________

Bank Phone # (______)_______________________________ Bank Fax # (______)____________________________

Type of Account: □Checking □Savings Checking Balance $____________ Savings Balance $______________

CREDIT REFERENCES

Please list all business debt and corresponding payment information:

Creditor Type of Business Contact Person Phone #

________________________ _________________________ _____________________ (______)____________

Address: _________________________________________________________________________________________ Number Street City State Zip

Opening Balance: $_________________ Outstanding Balance: $________________ PMT Amt: $__________________ Creditor Type of Business Contact Person Phone # ________________________ _________________________ _____________________ (______)____________

Address: _________________________________________________________________________________________ Number Street City State Zip

Opening Balance: $_________________ Outstanding Balance: $________________ PMT Amt: $__________________

CREDIT REFERENCES (continued) Creditor Type of Business Contact Person Phone #

________________________ _________________________ _____________________ (______)____________

Address: _________________________________________________________________________________________ Number Street City State Zip

Opening Balance: $_________________ Outstanding Balance: $________________ PMT Amt: $__________________

PRINCIPAL/OWNER/GUARANTOR INFORMATION

Name: ______________________________ SS # ____________________________ DOB: _______________________

Drivers License # ________________________________ Title: ___________________ % of Ownership: ____________

Employer: ___________________________________________________ Gross Income: $___________________

Employer Phone # (______)____________ Position: ___________________ Length of Employment: ________________

Home Address: __________________________________________________________________________________ Number Street City State Zip

□Rent □Own Rental/Mortgage Amount Paid Monthly $_____________ How Long at this address: ________________

Name: ______________________________ SS # ____________________________ DOB: _______________________

Drivers License # ________________________________ Title: ___________________ % of Ownership: ____________

Employer: ___________________________________________________ Gross Income: $___________________

Employer Phone # (______)____________ Position: ___________________ Length of Employment: ________________

Home Address: __________________________________________________________________________________ Number Street City State Zip

□Rent □Own Rental/Mortgage Amount Paid Monthly $_____________ How Long at this address: ________________

CERTIFICATION AND AUTHORIZATION

.

Signature:_____________________________________ Title: _________________________ Date: _____________

Signature:_____________________________________ Title: _________________________ Date: _____________

Submit to:

OFFICE USE ONLY

Space Applying for: ________________________ Square Footage: ______________